Health insurance open enrollment is a window of time that allows you to sign up or amend your health insurance coverage, usually running from November 1 to January 15. Whether you purchase insurance through the Health Insurance Marketplace or your employer, the deadline is most likely the same.
However, sometimes life gets busy, and you miss a deadline. While it’s important to complete your enrollment or changes during the open enrollment timeframe, there are some options if you miss it to avoid being uninsured.
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Why Staying Uninsured Is Risky
You probably already know that there is a significant risk associated with being uninsured. Health care costs are higher than ever, and if you have not experienced this personally, consider yourself lucky.
Cost is often a reason why individuals don’t purchase health insurance, but the cost of being uninsured can be devastating. According to the Centers for Medicare & Medicaid Services, the national health expenditure grew almost 10% in 2020, averaging almost $13,000 per person. There is an expected annual growth of about 5.4 percent over the next 6 years.
While there is no longer a tax penalty for not having health insurance, you should still consider purchasing it to save yourself some major financial trouble if you get sick or hurt. Sometimes doctors and hospitals will charge uninsured patients a higher rate than those who are insured.
Are You Eligible For a Special Enrollment Period or Qualifying Life Event?
Unless you have recently experienced a life-changing event that qualifies you for a special enrollment period, you may have to be without health insurance if you miss open enrollment.
Some qualifying life events include having a child, marriage or divorce, moving, age (like turning 26 and losing coverage under your parent’s policy, or 65 and becoming eligible for Medicare), and current health insurance changes. Typically, you will have 60 days to enroll in a policy, and you will need to provide proof of the event.
A special enrollment period could be triggered if you lose your coverage under someone else’s plan. As an example, if your spouse loses their job or you get divorced, your spouse’s health plan will trigger a special enrollment period. You can then enroll in your company’s health plan immediately.
There are some cases in which a qualifying life event does not trigger a special enrollment period. If you are a member of an indigenous tribe, you may qualify for assistance for American Indians and Alaska Natives. Low-income families who may qualify for the Children’s Health Insurance Program (CHIP) or Medicaid also have some special circumstances, such as if they lose eligibility.
Changes In Your Household
- Marriage/Divorce/Domestic Partnership – If you are a newlywed, you have had a qualifying life event if your spouse had already been covered for 60 days before your wedding. However, if you are newly divorced, your former spouse may not remain under your health plan. Once the divorce is finalized, they will be able to get their own plan during a special enrollment period. Make sure you do this as soon as possible to avoid committing insurance fraud. You may leave other dependents on your policy, though.
- Birth/Adoption/Foster Care – When a child is born, adopted, or taken into foster care, the parents are not required to have health insurance. If you do, you can add the child to your existing plan. Be sure to add them or obtain health insurance quickly, to avoid being uninsured.
Changes In Your Employment and Finances
- New Job/Change in Employment – Having health insurance through your employer is probably the easiest way to be insured but can present problems if you lose your job or start a new one. In both of these cases, you will trigger a qualifying life event. If your new employer doesn’t offer employer-sponsored insurance for some reason, you are eligible for the Health Insurance Marketplace. It is essential to note that if you quit your job on your own, this may not trigger a special enrollment period.
Changes In Your Location
- Moving – Some states have their own health insurance plans or more available options, so that could be a qualifying life event if you move states.
- Citizenship – If you recently became a United States citizen or had a lawful residency, that will trigger a particular enrollment period. Again, you will have 60 days to obtain health insurance, whether through an employer or the Health Insurance Marketplace.
- Incarceration Release – If you are incarcerated or have to serve time in prison, you could lose your health insurance. Once you are released, this could be considered a qualifying life event allowing you to obtain insurance again.
Changes In Your Age
- Parents Insurance – You may be covered under your parent’s health insurance policy until the age of 26. When you turn 26, you are no longer eligible to be on their plan and must obtain your own, usually at the end of the year when you had your birthday.
- Medicare – Medicare is for those 65 and older, so turning 65 is a qualifying life event in which you can then choose a Medicare plan. Your enrollment period for Medicare is 6 months long and begins 3 months before your birthday and ends 3 months after.
Changes In Your Current Health Insurance
- Losing Coverage – A special enrollment period may be available if you lose your health coverage involuntarily. You might lose coverage through a job, have your individual or group plan end during the year, or have your student health plan end. COBRA is a federal law that allows you to continue your employer-based health coverage for 18 months if you lose your job. You may enroll in your health insurance 60 days before or 60 days after the 18 months is over.
- Grandfathered Plan – Policies purchased before 3/23/2010 are grandfathered in. Some plans may lose their grandfathered status if they make significant changes that reduce benefits or increase consumer costs. Whether a health plan is grandfathered must be disclosed.
Enrolling in Medicaid and CHIP
The enrollment period for Medicaid and the Children’s Health Insurance Program (CHIP) is year-round. You can sign up anytime if you or your children qualify. Depending on the state, income eligibility varies considerably. You might be surprised to discover that the income limits are higher than expected, especially if you are applying for CHIP. Rather than remaining uninsured for the remainder of the year until the next open enrollment, check to see if you and your children may qualify.
What You’ll Need to Enroll in a Health Plan
When you are ready, you will need the following to enroll in a health insurance plan on the exchange (keep in mind that not all of these items will apply to you):
- Your personal information like name and date of birth
- Household information like spouse, dependents, and partners
- Address – mailing and living if they are different
- Social security numbers for each person in your household, even those who are not applying for coverage
- Immigration documents
- Tax filing information
- Employer and income – having your most recent W2 or taxes will be helpful here.
- Household income
- Current health insurance info
A Healthcare Option Without a Qualifying Life Event: Short-Term Health Insurance
You may not be eligible for a special enrollment period if you do not have a qualifying life event. If you want to ensure health coverage, you may take advantage of other options such as waiting until the next enrollment period or applying for a short-term plan.
Short-term health insurance gives you temporary coverage if you lose your permanent health insurance and don’t have a qualifying life event. The program covers people who change jobs, attend out-of-state colleges, or wait for the annual enrollment period to enroll again.
If you’re in reasonable health and qualify for a Medicare supplement, you can change your supplement at any time of the year. You might change your Medicare Advantage plan from January 7 through March 31 if you didn’t make any changes between October 15 and December 7.